World Health Organization · 1st edition, 2026 · 138 pages
A practical handbook for health-care workers to diagnose, treat and refer skin NTDs and common dermatoses at primary care level.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2026
- Audience
- Primary health-care workers, community health workers, general practitioners, nurses, public-health professionals
- Evidence
- Expert consensus; practical field-based guidance drawing on WHO technical guidelines for individual skin NTDs
- Reviewed
- 17 Oct 2026 · GMJ
What this guideline says
GMJ summary
This 138-page handbook provides front-line health workers in the WHO South-East Asia Region with a symptom-based, algorithmic approach to recognizing and managing skin-related neglected tropical diseases (NTDs) – leprosy, leishmaniasis (cutaneous and post-kala-azar dermal), lymphatic filariasis, deep mycoses (mycetoma, chromoblastomycosis, sporotrichosis), scabies, and yaws – alongside common skin conditions such as fungal, bacterial and viral infections, eczema, psoriasis and wounds.
Using a ‘look, ask and feel’ framework organized by six key skin lesion types (lumps, ulcers, swelling, patches, plaques, blisters), the handbook guides clinicians through differential diagnosis and decision-trees that indicate when to treat at primary level and when to refer. For each skin NTD it specifies cardinal signs, diagnostic criteria (including sensor testing for leprosy, rapid diagnostics for yaws and leishmaniasis, microscopy for scabies and deep mycoses), treatment regimens with exact doses (e.g. MDT blister packs for leprosy, single-dose azithromycin 30 mg/kg for yaws, ivermectin + DEC + albendazole for lymphatic filariasis, topical permethrin or oral ivermectin 200 µg/kg for scabies), and public-health measures such as contact tracing, mass drug administration and active case detection.
The handbook emphasizes early detection to prevent disability (nerve damage in leprosy, elephantiasis in LF, disfigurement in yaws and mycetoma), wound care principles, self-care and rehabilitation (lymphoedema management, footwear, eye protection), and community education to reduce stigma. Annexures include a training curriculum, case-based exercises, diagnostic criteria (IACS consensus for scabies), treatment tables for common conditions, and wound-care flowcharts.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Leprosy diagnosis requires ≥1 cardinal sign: hypopigmented patch with definite loss of sensation, thickened/enlarged peripheral nerve with loss of sensation/weakness, or acid-fast bacilli in slit-skin smear. Treat PB (1–5 lesions) with MDT for 6 months; MB (≥6 lesions or nerve involvement) for 12 months or more.
- Post-kala-azar dermal leishmaniasis (PKDL): suspect in patients with hypopigmented patches, papules or nodules symmetrically distributed (especially face/trunk) who have history of visceral leishmaniasis. Treat with miltefosine 2.5 mg/kg/day (≥25 kg 100 mg, <25 kg 50 mg) for 12 weeks or liposomal amphotericin B 5 mg/kg twice weekly for 8 weeks (total 40 mg/kg).
- Cutaneous leishmaniasis: simple CL (≤4 lesions <5 cm, non-exposed sites) may be treated with local therapy or 'wait and watch'; complex CL (>4 lesions or ≥5 cm, face/fingers/toes/genitalia, mucosal involvement, lymphadenopathy, immunocompromised) requires systemic therapy – refer for oral miltefosine or antimonial injections.
- Lymphatic filariasis: microfilaraemia detected by thick blood smear (20–60 µL) taken 10 pm–2 am (nocturnal periodicity in Asia) or rapid antigen test (Wuchereria bancrofti). Treat positive cases with ivermectin 200 µg/kg + DEC 6 mg/kg + albendazole 400 mg (single dose) in non-onchocerciasis countries. Lymphoedema management: daily hygiene, treat entry lesions, elevate at night, exercise, comfortable footwear; acute attacks require immediate antibiotics.
- Scabies: diagnose by intensely itchy widespread rash (worse at night), finger-web papules, burrows, nodules (genitalia in males); treat all household/close contacts simultaneously with oral ivermectin 200 µg/kg (>5 kg, not pregnant) or topical permethrin 5% or benzyl benzoate (adults 25%, children 12.5%) – apply neck-down for 8–12 hours (permethrin) or 24 hours (benzyl benzoate), repeat after one week. Wash bedding/clothing in hot water; vacuum carpets and mattresses.
- Yaws: painless papilloma ('mother yaw') or multiple lesions ('daughter yaws') with strawberry/cauliflower surface; thickened palms/soles; confirm with Dual Path Platform® Syphilis Screen & Confirm Assay. Treat with single oral azithromycin 30 mg/kg (max 2 g; 15–<20 kg 500 mg, 20–<35 kg 1000 mg, 35–<50 kg 1500 mg, ≥50 kg 2000 mg) or benzathine penicillin 2.4 MU IM (adults), 600 000–1.2 MU (children), repeat after 2 weeks. Total community treatment (TCT) for all residents in endemic communities.
- Deep mycoses (chromoblastomycosis, mycetoma, sporotrichosis): chronic, slowly progressive nodules/plaques with warty surface or draining sinuses discharging 'grains'; occupational exposure (farmers, foresters, animal handlers, barefoot walking); confirm by microscopy/biopsy/culture. Treatment prolonged (months to years): itraconazole, terbinafine, local heat, surgery. Mycetoma: 'woody' swelling, multiple sinuses, grains; actinomycetoma requires antibiotics (co-trimoxazole, amikacin).
- Leprosy reactions (Type 1 reversal, Type 2 ENL): acute onset redness/swelling of existing lesions or new painful nodules, often with neuritis, fever, joint pain; require immediate referral for oral corticosteroids to prevent permanent nerve damage and disability.
Treatment options for post-kala-azar dermal leishmaniasis (PKDL)
Table extracted from the guideline
| Treatment | Dosage | Duration |
|---|---|---|
| Miltefosine (oral)* | 2.5 mg/kg per day: 100 mg/day (≥25 kg); 50 mg/day (<25 kg) | 12 weeks |
| Liposomal amphotericin B (IV) | 5 mg/kg twice per week | 8 weeks (total dose 40 mg/kg) |
| Amphotericin B deoxycholate (IV) | 1 mg/kg per day | 40–80 doses over 4–6 months |
Source: World Health Organization, Integrated approach to management of skin-related neglected tropical diseases and common skin conditions. Reproduced in summary form.
From the guideline
Verbatim
“Skin lesions are so common in the community that many people neglect the conditions; they may think these are 'a part of their lives', they do not think that this is something for which they should seek care or which can be treated.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia and WHO consultant on health and migration, I see this handbook as a timely resource for strengthening integrated case management at the primary-care level – a cornerstone of Georgia's UHC programme since 2013. While endemic skin NTDs such as leprosy and lymphatic filariasis are not reported from Georgia, the South Caucasus region encounters sporadic imported cases among returning migrant workers, refugees from Afghanistan and the Middle East, and travelers, alongside endemic scabies outbreaks in institutions and IDP settlements. The handbook's symptom-based algorithms ('look, ask, feel') organized by visible lesion type (lumps, ulcers, patches) rather than disease name empower family doctors and PHC nurses to recognize conditions early, initiate first-line treatment (e.g. single-dose azithromycin for yaws, topical permethrin for scabies, MDT for leprosy), and refer appropriately – reducing diagnostic delay and preventing disability. I would stress to Georgian colleagues the importance of sensory testing for any hypopigmented skin patch (to exclude leprosy), contact tracing and simultaneous household treatment for scabies, and the five principles of wound care (wash, keep moist, timely dressing change, debride dead tissue, treat infection early) applicable to diabetic foot ulcers and post-traumatic wounds common in our setting. The realistic implementation challenge is ensuring availability of essential diagnostics (trained microscopists, rapid tests) and medicines (multi-drug therapy blister packs, ivermectin, quality-assured antifungals) in rural PHC facilities, alongside establishing clear referral pathways to regional dermatology and infectious-disease specialists – areas where Georgia's recent investments in laboratory networks (hepatitis C elimination programme since 2015, TB DOTS) and telemedicine infrastructure can be leveraged.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 17 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia and the South Caucasus are not endemic for the major skin NTDs covered (leprosy, lymphatic filariasis, yaws, leishmaniasis currently reported from countries further south and east), but the region faces occasional imported cases (migrant workers, refugees, travelers) and sporadic cutaneous leishmaniasis transmission in neighbouring areas. Scabies outbreaks occur in crowded settings (institutions, IDP camps). The handbook’s symptom-based algorithms, emphasis on early recognition and referral pathways, wound-care principles, and integration of skin health into primary care align with Georgia’s strengthened PHC (since 2013 UHC reforms) and disease-surveillance capacity. National programmes should adapt diagnostic and treatment protocols to local epidemiology, establish referral networks to dermatology/infectious-disease specialists, ensure availability of essential diagnostics (microscopy, rapid tests) and medicines (MDT, azithromycin, ivermectin, antifungals), train CHWs in symptom recognition, and incorporate skin-NTD surveillance into existing communicable-disease reporting.
Questions this guideline answers
Quick answers
How do I distinguish a leprosy patch from other hypopigmented skin lesions?
Test for loss of sensation (light touch with cotton wisp) on the patch and compare with surrounding normal skin; palpate peripheral nerves (greater auricular, ulnar, common peroneal, posterior tibial) for enlargement or tenderness. Leprosy patches typically show definite sensory loss (to touch, pain, temperature) and/or thickened nerves – features absent in pityriasis alba, pityriasis versicolor, vitiligo and PKDL. Refer for slit-skin smear if available.
When should I give oral ivermectin for scabies instead of topical permethrin?
Oral ivermectin 200 µg/kg is preferred for crusted (Norwegian) scabies, institutional outbreaks (prisons, care homes, refugee camps), patients unable to apply topicals correctly (very young children, elderly, disabled), and for treating all household/close contacts simultaneously. Do not give to pregnant women or children <5 kg. Both oral and topical treatments should be repeated after one week.
What is the 'Essential Package of Care' for lymphatic filariasis morbidity management?
Daily hygiene (wash affected limb with soap and water, dry thoroughly including between toes), treat bacterial/fungal entry lesions (antiseptic, antibiotic or antifungal creams), elevate limb at night and when resting, gentle low-intensity exercise to promote lymph flow, wear comfortable non-constricting footwear to prevent injury, and immediate antibiotic treatment of acute attacks (red, swollen, painful limb with fever). Self-care is life-long and must continue even after elimination targets are met.
How do I confirm yaws versus syphilis using the Dual Path Platform® rapid test?
The DPP® Syphilis Screen & Confirm detects both non-treponemal (Line 2) and treponemal (Line 1) antibodies. Active yaws: Line 1 positive AND Line 2 positive. Past/treated yaws or early infection: Line 1 positive, Line 2 negative. The test cannot distinguish yaws (Treponema pallidum pertenue) from syphilis (T. pallidum pallidum); interpretation requires clinical context – in children <15 years in yaws-endemic areas with typical painless papilloma/ulcer on limbs and no sexual contact, diagnose yaws. In sexually active adults, consider syphilis.
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- Issuer
- World Health Organization
- Type
- Handbook
- Edition
- 1st edition, 2026
- Status
- Current
- Published
- 2026-07-09
- Languages
- English
- Scope
- Skin-related neglected tropical diseases (leprosy, leishmaniasis, lymphatic filariasis, deep mycoses, scabies, yaws) and common skin conditions (fungal, bacterial, viral infections; inflammatory disorders; wounds) in WHO South-East Asia Region
- Audience
- Primary health-care workers, community health workers, general practitioners, nurses, public-health professionals
- Pages
- 138
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-9-280002-4
- Evidence
- Expert consensus; practical field-based guidance drawing on WHO technical guidelines for individual skin NTDs
- Record history
- Created 17 Oct 2026 · updated 17 Oct 2026 · next check Apr 2027
World Health Organization, Regional Office for South-East Asia. Integrated approach to management of skin-related neglected tropical diseases and common skin conditions: A practical handbook for health-care workers. New Delhi: WHO Regional Office for South-East Asia; 2026. 138 p. ISBN: 978-92-9-280002-4. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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